Late reproductive effects of cancer treatment in female survivors of childhood malignancy

In the last three decades, there has been a substantial improvement in survival rates of childhood cancers. As a result, we are encountering long-term sequlae of both the primary illness and of the therapy employed in treatment. The challenges include management of disorders of gonadal function, such as pubertal delay or failure, impaired menstruation, premature menopause and compromised fertility. When female survivors achieve a pregnancy, there is an increased risk of pregnancy loss, pre-term labour and intra-uterine growth retardation. Caesarean section, if required, may be complicated if the patient has had previous abdominal or pelvic surgery or radiotherapy.

A multidisciplinary approach is a vital component of the management of all long-term survivors of childhood cancer, particularly of pregnancies in female patients.